Nutrition therapy remains the conventional first-line approach to treatment of gestational diabetes mellitus (GDM). It will reach every woman with GDM across differing diagnostic criteria (1) and phenotypic heterogeneity (2). The goal of nutrition in pregnancy is to support maternal, placental, and fetal metabolic needs, and it may be the first introduction to a lifetime of healthy eating (3). In this way, nutrition therapy in GDM becomes an early-stage intervention in the vicious cycle of intergenerational obesity and diabetes (4). Importantly, because the prevalence of GDM has reached an alarming ≥20% of pregnancies (5), a cost-effective approach to management is urgently needed. While controlling fetal exposure to maternal hyperglycemia and overnutrition, effective nutrition can treat GDM in a way that is fiscally reasonable and culturally sensitive, ultimately reducing the need for medication and intensified health care resource use (1). The importance of nutrition therapy in GDM is a premise unlikely to be contested. Yet, the widely accepted approach rooted in carbohydrate restriction was challenged more than a decade ago based on concerns related to higher fat intake and exacerbation of maternal insulin resistance by free fatty acids (6,7). The dietary management of diabetes in pregnancy has remained in limbo ever since, with no specific guidelines for nutrition therapy in GDM, a travesty that has resulted in non–evidence-based, fragmented, and inconsistent approaches globally (8–12). Action is necessary not only because of the powerful influence of nutrition on fetal programming and development (13,14) but also because of the ability to positively impact the health of millions of mother-infant dyads. Currently, nutrition therapy appears to have become our Achilles heel, such that despite our strength, we have limped forward in generating clinical evidence to substantiate …